ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2019
Episiotomy use among vaginal deliveries and the association with anal sphincter injury: a population-based retrospective cohort study.
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Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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22citing papers in PubMed, 1 pooled it
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22 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Efficacy of energy-based devices on episiotomy pain and healing: A systematic review and meta-analysis.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Pooled it
- Inflammatory bowel disease and risk of perineal injury in primiparous vaginal births: a retrospective cohort study.Inflammatory bowel diseases · 2026Article
- Maternal and Fetal Outcomes of Contemporary Obstetric Interventions: A Systematic Review.Cureus · 2026Review
- Relationship between pregnancy, delivery, and ileal pouch-anal anastomosis for inflammatory bowel disease: a retrospective chart review.Crohn's & colitis 360 · 2026Article
- Episiotomy in Operative Vaginal Delivery Reduces the Risk of Obstetric Anal Sphincter Injuries in Nulliparous Women: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2026Review
- The Association Between Episiotomy and Obstetrical Anal Sphincter Injuries Among Vacuum-Assisted Vaginal Deliveries: A Population-Based Retrospective Canadian Cohort Study.International urogynecology journal · 2026Article
- Episiotomy and the risk of obstetric anal sphincter injury in nulliparous women with a prolonged second stage.Archives of gynecology and obstetrics · 2026Article
- Impact of gestational weight gain on perineal injury in overweight and obese primiparous women.Archives of gynecology and obstetrics · 2026Article
- Mediolateral episiotomy and obstetric anal sphincter injuries in nullipara: a propensity score matching study.BMC pregnancy and childbirth · 2025Article
- Prevalence and predictors of episiotomy among puerperal women accessing postnatal care in the Kumasi Metropolis.BMC pregnancy and childbirth · 2024Article
- Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked.BMJ (Clinical research ed.) · 2023Article
- Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score-matched observational study.AJOG global reports · 2023Article
- Episiotomy for Medical Indications during Vaginal Birth-Retrospective Analysis of Risk Factors Determining the Performance of This Procedure.Journal of clinical medicine · 2022Article
- Mediolateral episiotomy and risk of obstetric anal sphincter injuries and adverse neonatal outcomes during operative vaginal delivery in nulliparous women: a propensity-score analysis.BMC pregnancy and childbirth · 2022Observational
- Maternal and neonatal trauma following operative vaginal delivery.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Article
- Obstetric anal sphincter injury following previous vaginal delivery.International urogynecology journal · 2021Article
- Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach.African health sciences · 2021Article
- Health care workers' perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico.BMC pregnancy and childbirth · 2021Article
- Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China.BMJ open · 2021Article
- The authors respond to "Routine use of episiotomy with forceps should not be encouraged".CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Article
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Authors and funding
10 authors at 4 institutions in 3 countries.
Giulia M MuracaClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden giulia.muraca@ki.se.
Shiliang LiuClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Yasser SabrClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Sarka LisonkovaClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Amanda SkollClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Rollin BrantClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Geoffrey W CundiffClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Olof StephanssonClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
Neda RazazClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
K S JosephClinical Epidemiology Unit, Department of Medicine (Muraca, Stephansson, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph), University of British Columbia, Vancouver, BC; Maternal, Child and Youth Health Division (Liu), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Obstetrics and Gynaecology (Sabr), King Saud University, Riyadh, Saudi Arabia; School of Population and Public Health (Lisonkova, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology (Stephansson), Karolinska Institutet, Stockholm, Sweden.
King Saud University · SAKarolinska Institutet · SEKarolinska University Hospital · SEUniversity of British Columbia · CA
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe rate of obstetric anal sphincter injury has increased in recent years, particularly among operative vaginal deliveries. We sought to characterize temporal trends in episiotomy use and to quantify the association between episiotomy and obstetric anal sphincter injury.
methodsUsing a population-based retrospective cohort study design of hospital data from 2004 to 2017, we studied all vaginal deliveries of singleton infants at term gestation in Canada (excluding Quebec). Rates of obstetric anal sphincter injury were contrasted between women who had an episiotomy and those who did not. Log-binomial regression was used to estimate the association between episiotomy and obstetric anal sphincter injury among women with spontaneous and operative vaginal deliveries after controlling for confounders.
resultsThe study population included 2 570 847 deliveries. Episiotomy use declined significantly among operative vaginal deliveries (53.1% in 2004 to 43.2% in 2017,
interpretationEpisiotomy use has declined in Canada for all vaginal deliveries. The protective association between episiotomy and obstetric anal sphincter injury among women who gave birth by operative vaginal delivery (especially forceps) warrants reconsideration of clinical practice among nulliparous women and those attempting vaginal birth after cesarean.
Indexed as
AdultAnal CanalDelivery, ObstetricEpisiotomyFemaleFollow-Up StudiesHumansIncidenceInfant, NewbornObstetric Labor ComplicationsPopulation SurveillancePregnancyQuebecRetrospective StudiesRisk Factors
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